tag:blogger.com,1999:blog-20056539.post7622447446391107478..comments2017-01-21T06:19:17.045-08:00Comments on Movin' Meat: On Callshadowfaxhttp://www.blogger.com/profile/11648279307230813762noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-20056539.post-23885998594799831842016-12-27T22:11:25.312-08:002016-12-27T22:11:25.312-08:00Hello I Agree with you. I assume that is truly bru...Hello I Agree with you. I assume that is truly brutal. I am thankful that my nation is not in such conditions<br /><br />For Medical Equipment, Visit - <a href="http://bit.ly/2hUHg2d" rel="nofollow">www.tancolabproducts.com</a><br />Gopal Sukhijahttps://www.blogger.com/profile/04725994779709283818noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-58435229116518519122015-12-22T03:08:55.429-08:002015-12-22T03:08:55.429-08:00Thanks you very much for your informative and effe...Thanks you very much for your informative and effective post..http://www.afu.ac.ae/en/sau/vision-and-mission/Dora Alihttps://www.blogger.com/profile/01516701759533323483noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-85709180923186458662015-02-27T01:45:31.429-08:002015-02-27T01:45:31.429-08:00Mind-blowing..... presently I&#39;m running with a...Mind-blowing..... presently I&#39;m running with a local project, I hope it must be help me out. Thanks.<br /><br /><br><a href="http://medbookbank.com/index.php/medical-books/australian-medical-council/amc-handbook-of-multiple-choice-questions.html" rel="nofollow">AMC Handbook of Multiple Choice Questions</a><br />Carolyn Taylorhttps://www.blogger.com/profile/15259313800296163972noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-18412713880319076642015-02-09T22:09:15.372-08:002015-02-09T22:09:15.372-08:00Great info... Will share, it so deserves too!!!
D...Great info... Will share, it so deserves too!!!<br /><br /><a href="http://www.usmlestuff.com/index.php?main_page=product_info&amp;cPath=1_6&amp;products_id=24" rel="nofollow">Doctors in Training Step 2</a><br />DONELLA FLORENCEhttps://www.blogger.com/profile/14547428626306461013noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-80386197736396059542015-01-11T06:21:48.024-08:002015-01-11T06:21:48.024-08:00Thanks you very much for your informative and effe...Thanks you very much for your informative and effective post. Again thanks for sharing. <b><a href="http://www.xnxx247.com/" rel="nofollow">xnxx</a></b><br />Ruhul Quddushttps://www.blogger.com/profile/14269585774372598434noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-76032872048628664022015-01-06T18:25:52.362-08:002015-01-06T18:25:52.362-08:00Hey Shadowfax, lets get the facts straight. Most,...Hey Shadowfax, lets get the facts straight. Most, if not all, ER docs get paid regardless of the # of patients they see. Second, your a SHIFT worker! Which means when your off your completely off. How would you like to be called on your off time to place a foley at 3 AM? The specialists you talk about work daily, do night calls and then go back to a full day of work the next day...about 36 hrs straight, so forgive us if we would like to actually get some sleep so we can function properly. Your argument that we should continue to do this b/c this is the way it&#39;s been done for years is IDIOTIC!! Your grandstanding make get you points with the general public but anyone in the medical field with sense will shake their head at you. I have a suggestion. Next time you work in the ER let your hospital know that you would like to do a double shift but they only have to pay for 1 shift. You need to understand what the specialist go through before you grandstand against it.Ramu Chalasanihttps://www.blogger.com/profile/05293149870885107062noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-48513330313272462282015-01-05T22:02:08.114-08:002015-01-05T22:02:08.114-08:00MDs who are on call should get paid. It&#39;s cal...MDs who are on call should get paid. It&#39;s called trading time for money. <br />Sam Ko, MD, MBAhttps://www.blogger.com/profile/13630118338436072560noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-15487756980334881452014-12-22T07:23:47.873-08:002014-12-22T07:23:47.873-08:00I didn&#39;t know admitting to an inpatient servic...I didn&#39;t know admitting to an inpatient service by picking up the phone took so much energy. Abehttps://www.blogger.com/profile/03349310494748267601noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-62094348745707506442014-10-20T10:00:31.180-07:002014-10-20T10:00:31.180-07:00Tracker- I’m not sure what your point is. You pro...Tracker- I’m not sure what your point is. You provide 4 additional examples to the ones that I posted explaining why specialists are reluctant to see ER patients. All of them are valid. Your response to my post above can best be described as lamesnark. We don’t object to being called Providers, we object to being treated as Providers. You object to us then acting like Providers. You can’t have it both ways.<br /><br />I infer that you are an Emergency Physician. Undoubtedly you are aware of surgeons’ responsibility to provide ongoing care to our patients on a 24 hour basis, but some of our “civilian” readers may not be. The patients that you describe as “suck” often really do- they are often drug addicts, alcoholics, criminals, out of control obese and/or diabetic and/or hypertensive, and yes, often have no means or intention of paying a dime for their care. Your responsibility as ER doc ends when they are discharged from the ER or accepted by another physician. The accepting physician is responsible for that patient until the problem is resolved. The orthopedist on-call who drained that hand abscess is now obligated to follow that abscess until it is healed, and for a year (typically) afterward. No matter how many times he shows up in your ER at 2 a.m. with a real or imagined problem with his hand, the orthopod has to evaluate and treat the patient in a timely manner. You will have to see him also, if he happens to show up during your shift, but otherwise it will be another Emergency physician who will be relieved to see in the record that the patient is established with Dr. Ortho, and Dr. Ortho is obligated to see him, no matter what. <br /><br />I have worked collaboratively with dozens of Emergency Physicians during my career. I have had an excellent working relationship with all of them- I recall zero events where the patient’s best interest was not served. Occasionally, the ER doc calls just for advice or to get approval to send the patient to my office the next day, but I overrule him and say that I need to see or admit the patient now. Emergency physicians know what a burden call is to docs, and call reluctantly, and I responded appropriately until the burden became unreasonable for me, and I quit my on-call job. Now there is one fewer person for them to call in my community. Yes, it sucks to be an ER doc who can’t find a specialist to take over his problem patient. Emergency physicians are not the cause of the problem. The cause of the problem is the actions of the lawyers, legislators, regulators, and administrators who have created the world that we all have to live in. Surgeons as a group are not organized enough to march in the streets, form effective lobbying organizations, or otherwise raise a ruckus. We just decide we have had enough, and stop showing up at 2 a.m. to Provide to the sucky patients. They are getting what they asked for, good and hard. I suspect that it will take some senator’s daughter dying for lack of an available specialist in the middle of the night before anyone important starts paying attention. That will be a tragedy, one of their own making.<br />West Texas Intermediate Crudehttps://www.blogger.com/profile/12329818542280388890noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-14797536298022601462014-10-17T19:10:41.125-07:002014-10-17T19:10:41.125-07:00Needless to say, I have this problem also -- we al...Needless to say, I have this problem also -- we all do. On my last shift, I had a bad hand abscess. Local ortho and three transfer centers (including two large trauma centers) all refused the patient. I was getting set up to open the hand and semi-drain it myself to buy time -- a cowboy move, admittedly, but what could I do? -- when the ortho on call, thankfully, decided their doing it in the OR was at least better than me doing it in the ED.<br /><br />I see a number of factors intersecting to create this problem:<br /><br />1. Subspecialization. The scope that specialist are willing to operate across narrows further and further as people specialize and do fellowships in things every surgeon (or what have you) used to be expected to do. I don&#39;t blame the consultants (mostly.) Once a specialist exists you&#39;re judged by what they would have done if they&#39;d been there or you&#39;d sent the patient to them; that logic drives a lot of EM consultations and by the same token, can drive ortho to refuse to treat hands or GI to refuse to see a kid.<br /><br />2. EM patients suck. Let&#39;s face it, folks, they do. When I call a consultant, what they here is &quot;Hey, I&#39;ve got a medically complicated, likely noncompliant abuser of several substances with no insurance and who hasn&#39;t paid a medical bill since 1963. Can you come in and take them off my hands?&quot;<br /><br />3. Ongoing responsibility. The one part of armydocs&#39; bile-soaked excreta I agree with is this: It must truly suck to be responsible for the aforementioned ED patient on an ongoing basis because you did a procedure on them. Maybe that convention needs to change, and we need to collectively agree that an ED consult/procedure does not mean you &quot;own&quot; that patient beyond, say, two or three follow up visits.<br /><br />4. Technology. Surgical and many medical specialists used to need hospitals to ply their trade. That leverage is disappearing with private surgery centers, outpatient labs and imaging, and the ability to do more and more from the office. <br /><br />I don&#39;t have a solution, but I see it as a mixture of carrots (legal protections, limits to ongoing responsibility, expanding Medicaid and other insurance to ensure they get something for their time) and sticks (we can&#39;t rely on a tradition of specialists stepping up and taking responsibility for these patient, so we need some kind of requirement -- no doing colonoscopies all day for private patients and ignoring the GI bleed two miles away.) <br /><br />IDK. It&#39;s a depressing thing.TheTrackerhttps://www.blogger.com/profile/10011829472333355911noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-39755058245141232402014-10-17T18:47:16.561-07:002014-10-17T18:47:16.561-07:00There you have it, folks: JCAHO is why Hand surgeo...There you have it, folks: JCAHO is why Hand surgeons won&#39;t take call. Also, someone called him a &quot;provider,&quot; and so he&#39;s refusing to work nights or weekends until that semantic atrocity is repudiated. <br /><br />I&#39;m surprised he didn&#39;t just come out and blame Obama. Maybe he&#39;s working up to it.TheTrackerhttps://www.blogger.com/profile/10011829472333355911noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-69179949452287078372014-10-17T18:43:16.541-07:002014-10-17T18:43:16.541-07:00Wow, somebody&#39;s defensive about telling patien...Wow, somebody&#39;s defensive about telling patients in need to go screw themselves.<br /><br />I really thought we were past this nonsense of other specialities whining about EM, but I suppose the whiners are not quite dead yet.TheTrackerhttps://www.blogger.com/profile/10011829472333355911noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-59256549416632935732014-10-08T09:54:45.967-07:002014-10-08T09:54:45.967-07:00A bit late to this discussion, but this is importa...A bit late to this discussion, but this is important.<br />Over a 2+ decade career as a physician and surgeon, I have seen both sides of this story. <br />No other profession allows itself to be abused in this way- obligated to be available on a 24 hour basis, held responsible for outcomes that are only partially under our control. Subject to retrospective review by well-paid critics who evaluate our work, work that we may do at 2 a.m. under severe stress, in chaotic ERs or ORs, with inadequate information. Their evaluations occur at 2 p.m. in the comfort of their carpeted offices.<br />Why do we do it? Originally, we did it because we knew that if we did not do it, people would die, people who with our help are alive and functional. Not all of them, mind you, but enough to make it worthwhile. We did the best we could with what we had to work with. It was often but not always successful. Our non-physician fellow citizens understood that, appreciated and respected our work, and allowed us to go about our business. We often but not always got paid, and we continued to do it because we though t it was important. We had meaningful, sometimes brutal M&amp;M conferences, to confront our mistakes, and improve our work. Now we have Quality Improvement Nurses who screen our charts for evidence of malfeasance.<br />What happened then was it was noticed that 16% of the economy was running on its own. Can’t have that. Now every aspect of medicine is supervised, regulated, overseen by a vast array of governmental and quasi-governmental (think JCAHO and Blue Cross) bureaucracies and rent-seekers that decide who we will care for, when we will care for them, how etc., where etc., and what our payment will be. We are told that many things that are out of our control are hereafter deemed “NEVER” events, so if they occur, we have screwed up by definition. We are now “Providers” of “Healthcare.”<br />So be it. You have taken away our ability to self-regulate. We will work under your regulations. We will work just so much, and that is it. We no longer work for the benefit of the patient. We work to satisfy the “indicators.” Did my patient get a DVT? In the old days, I felt terrible about that. Now, all I care about is if I ordered the correct protocol of DVT preventive measures as mandated by CMS. If I did, I’m untouchable. What, the client is in the ICU on a ventilator??? Not my problem, I ordered the right stuff. You can’t hurt me. Maybe it’s the nurse’s fault if the SCDs were not applied properly, or the heparin dose was delayed. Go bother someone else.<br />I long ago gave up my private practice. I no longer take ER call. I am a shift worker. Once the clock strikes 7, it’s not my problem. I make less money, but I sleep at night. <br />You see, there is nothing more rewarding than taking charge of a desperately ill patient, and navigating through the shoals of disaster to guide him through to recovery. <br />There is nothing less rewarding than meeting indicators, satisfying SCIP “guidelines,” and being a “provider” of “healthcare,” avoiding Never events.<br />It’s now all dollars and cents, meeting your numbers, avoiding having your charts “fall out” during Quality Improvement review. If a hospital employee truly screws up and actually threatens the well-being of our patients, we hold our tongues, lest we be deemed “disruptive.”<br />And that’s why you have trouble with your call schedule.<br />West Texas Intermediate Crudehttps://www.blogger.com/profile/12329818542280388890noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-58889628227281545862014-09-09T03:23:13.527-07:002014-09-09T03:23:13.527-07:00Very impressive new way and type presentation of t...Very impressive new way and type presentation of thoughts.<br /><br /><a href="http://www.usmlestuff.com/index.php?main_page=product_info&amp;cPath=1_6&amp;products_id=116" rel="nofollow">Kaplan Step 2 ck Classroom Anywhere</a><br />DONELLA FLORENCEhttps://www.blogger.com/profile/14547428626306461013noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-89226871874067164932014-08-27T11:10:16.694-07:002014-08-27T11:10:16.694-07:00Shiftworker??its because of people like him that y...Shiftworker??its because of people like him that your mom and dad gets proper Care for for a wide variety if acute conditions at odd timings while ur halfway across the country ..it takes guts to fight from the frontlines of medicine ..not something the slow paced schmucks will understandprometheaushttps://www.blogger.com/profile/08201144434266718296noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-62111484373522382272014-08-14T19:03:25.092-07:002014-08-14T19:03:25.092-07:00The clock-punching shift-worker wags a finger at s...The clock-punching shift-worker wags a finger at specialists who make a calculated decision to control their lives and save their elective practice and perhaps their marriage and family. Specialists who, when they take on a patient, are responsible for them on an ongoing basis. Something that the clock-punching shift-worker knows nothing about. Once he punches out, that patient is never his responsibility again, unless he happens to show up at his next shift. The clock-punching shift-worker will never have a clinic day or elective OR day destroyed by an emergency, delaying the care of multiple patients. &quot;Structure your practices to make call suck a little less, maybe&quot;, he says. Newsflash, clock-puncher- THERE&#39;S NOT ENOUGH OF US. Additionally, most communities can&#39;t support a practice of 6 or more specialists that would make call frequency bearable and allow the on-call guy not to do elective work. Here&#39;s an idea- how about the hospitals hire their own specialists for call purposes? They have tried but are unsuccessful because THERE&#39;S NOT ENOUGH OF US. So, don&#39;t even try with the &quot;do the right thing&quot; schtick. The dedication of the specialists you so freely denigrate puts your clock-punching, shift-working butt to shame.armydochttps://www.blogger.com/profile/14558198453125739705noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-11487064332869073082014-07-30T04:52:59.133-07:002014-07-30T04:52:59.133-07:00OK, so after pounding sand and chest thumping, how...OK, so after pounding sand and chest thumping, how do you handle patients who really do need that consult?Arthur Fougner MDhttps://www.blogger.com/profile/01289871715221493960noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-65933760542050059962014-07-08T02:17:07.851-07:002014-07-08T02:17:07.851-07:00I suppose that is really harsh. I am grateful that...I suppose that is really harsh. I am grateful that my country is not in such circumstances (and by saying this, I am not in any way glad that this had happened anywhere in this world)<br /><br />btw Dr, do you mind if I share a link to this post in my fb account? MEhttps://www.blogger.com/profile/10720080723032836012noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-57420809738388325262014-07-07T12:31:54.240-07:002014-07-07T12:31:54.240-07:00And we are also a &quot;regional health center.&qu...And we are also a &quot;regional health center.&quot;thethingspatientssayhttps://www.blogger.com/profile/09926686175578949475noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-62463320008652513932014-07-07T12:31:22.212-07:002014-07-07T12:31:22.212-07:00We have the same problem at our facility. Neurolo...We have the same problem at our facility. Neurology, GI, ENT are the most prominent, but the cardiologists have decided they don&#39;t want to cover weekends now, too.thethingspatientssayhttps://www.blogger.com/profile/09926686175578949475noreply@blogger.com